Department of Health and Human Services

Office of Inspector General -- AUDIT

"Post Retirement Benefit Costs Claimed by Horizon Blue Cross Blue Shield of New Jersey," (A-07-03-03044)

August 6, 2004

Complete Text of Report is available in PDF format (130 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


The objective of  this review was to determine the allowability of $2,652,795 in Post Retirement Benefit (PRB) costs claimed for Medicare reimbursement by Horizon Blue Cross Blue Shield of New Jersey (Horizon).   The $2,652,795 represents PRB costs that will be incurred subsequent to the termination of Horizonís Medicare contract.  We found that Horizonís claim for $2,652,795 of PRB costs is unallowable for Medicare reimbursement.  We recommended that Horizon withdraw its claim for the $2,652,795 of unallowable PRB costs.  Horizon did not comment on our finding and recommendation.